Provider Demographics
NPI:1881657922
Name:KJOS, SIRI L (MD)
Entity Type:Individual
Prefix:
First Name:SIRI
Middle Name:L
Last Name:KJOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9260 W. SUNSET RD.
Mailing Address - Street 2:STE. 200
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-4903
Mailing Address - Country:US
Mailing Address - Phone:702-255-3547
Mailing Address - Fax:702-921-2419
Practice Address - Street 1:5320 S. RAINBOW BLVD.
Practice Address - Street 2:STE. 182
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118
Practice Address - Country:US
Practice Address - Phone:702-255-3547
Practice Address - Fax:702-921-2419
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG51234207VM0101X
NV15288207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G512340Medicaid
CAWG51234QMedicare PIN
CAE83570Medicare UPIN
CA00G512340Medicaid
CAWG51234DMedicare PIN
CAWG51234RMedicare PIN